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Using Respondent-Driven Sampling in a Hidden Population at Risk of HIV Infection: Who Do HIV-Positive Recruiters Recruit?

Abramovitz, Daniela MS*; Volz, Erik M. PHD; Strathdee, Steffanie A. PHD*; Patterson, Thomas L. PHD; Vera, Alicia MPH*; Frost, Simon D. W. PHD§¶for Proyecto ElCuete

doi: 10.1097/OLQ.0b013e3181b0f311

Background: Respondent-driven sampling (RDS) is a network-based method used to recruit hidden populations. Since it is respondent-driven, RDS is prone to bias. However, these biases could facilitate recruitment of high-risk networks. We examined recruitment patterns of human immunodeficiency virus (HIV)-positive injection drug users (IDUs) and identified factors associated with being recruited by an HIV-positive IDU in a RDS-based study.

Methods: IDUs aged ≥18, who injected within the last month and resided in Tijuana, Mexico, were recruited using RDS and underwent interviews and testing for HIV, syphilis, and tuberculosis. Weighted logistic regression was used to identify predictors of being recruited by an HIV-positive IDU.

Results: Of 1056 IDUs, HIV-positive subjects comprised 4.4% of the sample and generated 4.7% of recruits, indicating that recruitment effectiveness did not vary by HIV-status. However, 10% of the subjects recruited by HIV-positive recruiters were infected with HIV as compared to 4.1% of subjects recruited by HIV-negative recruiters, (P = 0.06), a difference that, after controlling for whether the recruiter and recruit injected drugs together, attained statistical significance (P = 0.04), indicating that recruitment patterns differed by HIV-status. Factors independently associated with being recruited by an HIV-positive IDU included lifetime syphilis infection, ever having sex with an HIV-positive person, knowing someone with HIV/AIDS, being recruited at a shooting gallery, having recently used the local needle exchange program, and having a larger number of recent arrests for track marks.

Conclusion: HIV-positive IDUs have different recruitment patterns than HIV-negative IDUs, with HIV-positive IDUs tending to recruit other HIV-positive IDUs. Social and environmental factors along with risk behaviors were independently associated with being the recruit of an HIV-positive IDU in Tijuana. Although the goal of this study was not to recruit HIV+ or other high-risk persons, our results suggest that RDS has the potential to successfully be used in the identification of HIV+ or other high risk individuals.

An respondent-driven sampling–based study of injection drug users in Tijuana, Mexico, found that beyond success in recruiting hidden populations, respondent driven sampling may facilitate the identification of persons with undiagnosed HIV infection and high-risk networks.

From the *Department of Medicine, University of California San Diego, La Jolla, CA; †Antiviral Research Center, University of California San Diego, La Jolla, CA; ‡Department of Veterans Affairs Medical Center San Diego, La Jolla, CA; §Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom; and ¶Department of Pathology and Antiviral Research Center, University of California, San Diego, CA

The authors thank the contributions of study participants and binational staff and investigators from the University of California San Diego and Pro-COMUSIDA, Tijuana, Mexico.

Supported by the National Institute on Drug Abuse (Proyecto ElCuete) (NIDA; grant: R01DA019829), by the National Institutes of Health grant (4 T32 AI07384) (to E.V.), and by the National Institute of Nursing Research grant (NR10961) and by the Royal Society Wolfson Research Merit Award (to S.F.).

Correspondence: Steffanie A. Strathdee, PhD, Institute of the Americas, 10111 N. Torrey Pines Rd, La Jolla, CA 92093. E-mail:

Received for publication February 13, 2009, and accepted June 1, 2009.

© Copyright 2009 American Sexually Transmitted Diseases Association